|
HC DRSNG NON-ADHERENT 3 X 8
|
Facility
|
IP
|
$18.53
|
|
| Hospital Charge Code |
901600311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.68 |
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.41
|
| Rate for Payer: Galaxy Health WC |
$15.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.04
|
| Rate for Payer: Prime Health Services Commercial |
$15.75
|
|
|
HC DRSNG NON-ADHERENT 3 X 8
|
Facility
|
OP
|
$18.53
|
|
| Hospital Charge Code |
901600311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$16.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.95
|
| Rate for Payer: Blue Distinction Transplant |
$11.12
|
| Rate for Payer: Blue Shield of California Commercial |
$11.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.06
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Central Health Plan Commercial |
$14.82
|
| Rate for Payer: Cigna of CA HMO |
$11.86
|
| Rate for Payer: Cigna of CA PPO |
$13.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.75
|
| Rate for Payer: Dignity Health Media |
$15.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.41
|
| Rate for Payer: Galaxy Health WC |
$15.75
|
| Rate for Payer: Global Benefits Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.71
|
| Rate for Payer: Multiplan Commercial |
$13.90
|
| Rate for Payer: Networks By Design Commercial |
$12.04
|
| Rate for Payer: Prime Health Services Commercial |
$15.75
|
| Rate for Payer: Riverside University Health System MISP |
$7.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.26
|
| Rate for Payer: United Healthcare All Other HMO |
$9.26
|
| Rate for Payer: United Healthcare HMO Rider |
$9.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.75
|
| Rate for Payer: Vantage Medical Group Senior |
$15.75
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X4"
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901607908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X4"
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
CPT A6251
|
| Hospital Charge Code |
901607908
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.34
|
| Rate for Payer: Blue Distinction Transplant |
$0.34
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.28
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Media |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X8"
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901607909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$8.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Blue Distinction Transplant |
$0.54
|
| Rate for Payer: Blue Shield of California Commercial |
$0.57
|
| Rate for Payer: Blue Shield of California EPN |
$0.44
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$0.58
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Media |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Riverside University Health System MISP |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
HC DRSNG NON-ADH PAD TELFA 3X8"
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
CPT A6252
|
| Hospital Charge Code |
901607909
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
HC DRSNG, OPTIFOAM 4X4IN NON-ADH
|
Facility
|
IP
|
$18.86
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$16.97 |
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Central Health Plan Commercial |
$15.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.54
|
| Rate for Payer: Galaxy Health WC |
$16.03
|
| Rate for Payer: Global Benefits Group Commercial |
$11.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: Networks By Design Commercial |
$12.26
|
| Rate for Payer: Prime Health Services Commercial |
$16.03
|
|
|
HC DRSNG, OPTIFOAM 4X4IN NON-ADH
|
Facility
|
OP
|
$18.86
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$19.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.14
|
| Rate for Payer: Blue Distinction Transplant |
$11.32
|
| Rate for Payer: Blue Shield of California Commercial |
$11.86
|
| Rate for Payer: Blue Shield of California EPN |
$9.22
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Cash Price |
$8.49
|
| Rate for Payer: Central Health Plan Commercial |
$15.09
|
| Rate for Payer: Cigna of CA HMO |
$12.07
|
| Rate for Payer: Cigna of CA PPO |
$13.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.03
|
| Rate for Payer: Dignity Health Media |
$16.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.54
|
| Rate for Payer: Galaxy Health WC |
$16.03
|
| Rate for Payer: Global Benefits Group Commercial |
$11.32
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.77
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: Networks By Design Commercial |
$12.26
|
| Rate for Payer: Prime Health Services Commercial |
$16.03
|
| Rate for Payer: Riverside University Health System MISP |
$7.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.43
|
| Rate for Payer: United Healthcare All Other HMO |
$9.43
|
| Rate for Payer: United Healthcare HMO Rider |
$9.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.03
|
| Rate for Payer: Vantage Medical Group Senior |
$16.03
|
|
|
HC DRSNG, OPTIFOAM 6X6IN NON-ADH
|
Facility
|
OP
|
$36.49
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901607528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$52.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.56
|
| Rate for Payer: Blue Distinction Transplant |
$21.89
|
| Rate for Payer: Blue Shield of California Commercial |
$22.95
|
| Rate for Payer: Blue Shield of California EPN |
$17.84
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Central Health Plan Commercial |
$29.19
|
| Rate for Payer: Cigna of CA HMO |
$23.35
|
| Rate for Payer: Cigna of CA PPO |
$27.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Media |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$27.37
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Riverside University Health System MISP |
$14.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.24
|
| Rate for Payer: United Healthcare All Other HMO |
$18.24
|
| Rate for Payer: United Healthcare HMO Rider |
$18.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
HC DRSNG, OPTIFOAM 6X6IN NON-ADH
|
Facility
|
IP
|
$36.49
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901607528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Central Health Plan Commercial |
$29.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$27.37
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
|
|
HC DRSNG,OPTIFOAM AG 4X4" NON-ADH
|
Facility
|
IP
|
$35.67
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$32.10 |
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Central Health Plan Commercial |
$28.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: Galaxy Health WC |
$30.32
|
| Rate for Payer: Global Benefits Group Commercial |
$21.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: Networks By Design Commercial |
$23.19
|
| Rate for Payer: Prime Health Services Commercial |
$30.32
|
|
|
HC DRSNG,OPTIFOAM AG 4X4" NON-ADH
|
Facility
|
OP
|
$35.67
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$32.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.07
|
| Rate for Payer: Blue Distinction Transplant |
$21.40
|
| Rate for Payer: Blue Shield of California Commercial |
$22.44
|
| Rate for Payer: Blue Shield of California EPN |
$17.44
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Cash Price |
$16.05
|
| Rate for Payer: Central Health Plan Commercial |
$28.54
|
| Rate for Payer: Cigna of CA HMO |
$22.83
|
| Rate for Payer: Cigna of CA PPO |
$26.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.32
|
| Rate for Payer: Dignity Health Media |
$30.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.27
|
| Rate for Payer: Galaxy Health WC |
$30.32
|
| Rate for Payer: Global Benefits Group Commercial |
$21.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.13
|
| Rate for Payer: Multiplan Commercial |
$26.75
|
| Rate for Payer: Networks By Design Commercial |
$23.19
|
| Rate for Payer: Prime Health Services Commercial |
$30.32
|
| Rate for Payer: Riverside University Health System MISP |
$14.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.84
|
| Rate for Payer: United Healthcare All Other HMO |
$17.84
|
| Rate for Payer: United Healthcare HMO Rider |
$17.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.32
|
| Rate for Payer: Vantage Medical Group Senior |
$30.32
|
|
|
HC DRSNG OPTIFOAM HRTMATE
|
Facility
|
OP
|
$8.77
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.18
|
| Rate for Payer: Blue Distinction Transplant |
$5.26
|
| Rate for Payer: Blue Shield of California Commercial |
$5.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.02
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$6.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.45
|
| Rate for Payer: Dignity Health Media |
$7.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$6.58
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
| Rate for Payer: Riverside University Health System MISP |
$3.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7.45
|
|
|
HC DRSNG OPTIFOAM HRTMATE
|
Facility
|
IP
|
$8.77
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$6.58
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
|
|
HC DRSNG OPTIFOAM SACRUM 7X7"
|
Facility
|
OP
|
$49.53
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$44.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.26
|
| Rate for Payer: Blue Distinction Transplant |
$29.72
|
| Rate for Payer: Blue Shield of California Commercial |
$31.15
|
| Rate for Payer: Blue Shield of California EPN |
$24.22
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Central Health Plan Commercial |
$39.62
|
| Rate for Payer: Cigna of CA HMO |
$31.70
|
| Rate for Payer: Cigna of CA PPO |
$36.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.10
|
| Rate for Payer: Dignity Health Media |
$42.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.81
|
| Rate for Payer: Galaxy Health WC |
$42.10
|
| Rate for Payer: Global Benefits Group Commercial |
$29.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.91
|
| Rate for Payer: Multiplan Commercial |
$37.15
|
| Rate for Payer: Networks By Design Commercial |
$32.19
|
| Rate for Payer: Prime Health Services Commercial |
$42.10
|
| Rate for Payer: Riverside University Health System MISP |
$19.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.76
|
| Rate for Payer: United Healthcare All Other HMO |
$24.76
|
| Rate for Payer: United Healthcare HMO Rider |
$24.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.10
|
| Rate for Payer: Vantage Medical Group Senior |
$42.10
|
|
|
HC DRSNG OPTIFOAM SACRUM 7X7"
|
Facility
|
IP
|
$49.53
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.91 |
| Max. Negotiated Rate |
$44.58 |
| Rate for Payer: Cash Price |
$22.29
|
| Rate for Payer: Central Health Plan Commercial |
$39.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.81
|
| Rate for Payer: Galaxy Health WC |
$42.10
|
| Rate for Payer: Global Benefits Group Commercial |
$29.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.91
|
| Rate for Payer: Multiplan Commercial |
$37.15
|
| Rate for Payer: Networks By Design Commercial |
$32.19
|
| Rate for Payer: Prime Health Services Commercial |
$42.10
|
|
|
HC DRSNG OPTIFOAM SACRUM 9X9"
|
Facility
|
OP
|
$79.46
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$71.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.94
|
| Rate for Payer: Blue Distinction Transplant |
$47.68
|
| Rate for Payer: Blue Shield of California Commercial |
$49.98
|
| Rate for Payer: Blue Shield of California EPN |
$38.86
|
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Central Health Plan Commercial |
$63.57
|
| Rate for Payer: Cigna of CA HMO |
$50.85
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.54
|
| Rate for Payer: Dignity Health Media |
$67.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.78
|
| Rate for Payer: Galaxy Health WC |
$67.54
|
| Rate for Payer: Global Benefits Group Commercial |
$47.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.89
|
| Rate for Payer: Multiplan Commercial |
$59.60
|
| Rate for Payer: Networks By Design Commercial |
$51.65
|
| Rate for Payer: Prime Health Services Commercial |
$67.54
|
| Rate for Payer: Riverside University Health System MISP |
$31.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.73
|
| Rate for Payer: United Healthcare All Other HMO |
$39.73
|
| Rate for Payer: United Healthcare HMO Rider |
$39.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.54
|
| Rate for Payer: Vantage Medical Group Senior |
$67.54
|
|
|
HC DRSNG OPTIFOAM SACRUM 9X9"
|
Facility
|
IP
|
$79.46
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.89 |
| Max. Negotiated Rate |
$71.51 |
| Rate for Payer: Cash Price |
$35.76
|
| Rate for Payer: Central Health Plan Commercial |
$63.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.78
|
| Rate for Payer: Galaxy Health WC |
$67.54
|
| Rate for Payer: Global Benefits Group Commercial |
$47.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.89
|
| Rate for Payer: Multiplan Commercial |
$59.60
|
| Rate for Payer: Networks By Design Commercial |
$51.65
|
| Rate for Payer: Prime Health Services Commercial |
$67.54
|
|
|
HC DRSNG OVAL #8, 4.0X5.7" SLCN
|
Facility
|
OP
|
$61.34
|
|
| Hospital Charge Code |
901698351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.24
|
| Rate for Payer: Blue Distinction Transplant |
$36.80
|
| Rate for Payer: Blue Shield of California Commercial |
$38.58
|
| Rate for Payer: Blue Shield of California EPN |
$30.00
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Central Health Plan Commercial |
$49.07
|
| Rate for Payer: Cigna of CA HMO |
$39.26
|
| Rate for Payer: Cigna of CA PPO |
$45.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.14
|
| Rate for Payer: Dignity Health Media |
$52.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.54
|
| Rate for Payer: Galaxy Health WC |
$52.14
|
| Rate for Payer: Global Benefits Group Commercial |
$36.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$46.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.27
|
| Rate for Payer: Multiplan Commercial |
$46.00
|
| Rate for Payer: Networks By Design Commercial |
$39.87
|
| Rate for Payer: Prime Health Services Commercial |
$52.14
|
| Rate for Payer: Riverside University Health System MISP |
$24.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.67
|
| Rate for Payer: United Healthcare All Other HMO |
$30.67
|
| Rate for Payer: United Healthcare HMO Rider |
$30.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.14
|
| Rate for Payer: Vantage Medical Group Senior |
$52.14
|
|
|
HC DRSNG OVAL #8, 4.0X5.7" SLCN
|
Facility
|
IP
|
$61.34
|
|
| Hospital Charge Code |
901698351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$55.21 |
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Central Health Plan Commercial |
$49.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.54
|
| Rate for Payer: Galaxy Health WC |
$52.14
|
| Rate for Payer: Global Benefits Group Commercial |
$36.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.27
|
| Rate for Payer: Multiplan Commercial |
$46.00
|
| Rate for Payer: Networks By Design Commercial |
$39.87
|
| Rate for Payer: Prime Health Services Commercial |
$52.14
|
|
|
HC DRSNG PACKING STRIPS 1/4"IODO
|
Facility
|
IP
|
$1,283.40
|
|
| Hospital Charge Code |
901600274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.68 |
| Max. Negotiated Rate |
$1,155.06 |
| Rate for Payer: Cash Price |
$577.53
|
| Rate for Payer: Central Health Plan Commercial |
$1,026.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.36
|
| Rate for Payer: Galaxy Health WC |
$1,090.89
|
| Rate for Payer: Global Benefits Group Commercial |
$770.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,155.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$856.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$962.55
|
| Rate for Payer: Networks By Design Commercial |
$834.21
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.89
|
|
|
HC DRSNG PACKING STRIPS 1/4"IODO
|
Facility
|
OP
|
$1,283.40
|
|
| Hospital Charge Code |
901600274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.68 |
| Max. Negotiated Rate |
$1,155.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$779.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,090.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$705.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$705.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$621.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.23
|
| Rate for Payer: Blue Distinction Transplant |
$770.04
|
| Rate for Payer: Blue Shield of California Commercial |
$807.26
|
| Rate for Payer: Blue Shield of California EPN |
$627.58
|
| Rate for Payer: Cash Price |
$577.53
|
| Rate for Payer: Central Health Plan Commercial |
$1,026.72
|
| Rate for Payer: Cigna of CA HMO |
$821.38
|
| Rate for Payer: Cigna of CA PPO |
$949.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,090.89
|
| Rate for Payer: Dignity Health Media |
$1,090.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,090.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$513.36
|
| Rate for Payer: Galaxy Health WC |
$1,090.89
|
| Rate for Payer: Global Benefits Group Commercial |
$770.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,155.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$962.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$449.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$856.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$962.55
|
| Rate for Payer: Networks By Design Commercial |
$834.21
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.89
|
| Rate for Payer: Riverside University Health System MISP |
$513.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$770.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$770.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.70
|
| Rate for Payer: United Healthcare All Other HMO |
$641.70
|
| Rate for Payer: United Healthcare HMO Rider |
$641.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,090.89
|
| Rate for Payer: Vantage Medical Group Senior |
$1,090.89
|
|
|
HC DRSNG PACKING STRIPS 1" PLAIN
|
Facility
|
OP
|
$14.43
|
|
| Hospital Charge Code |
901600272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.53
|
| Rate for Payer: Blue Distinction Transplant |
$8.66
|
| Rate for Payer: Blue Shield of California Commercial |
$9.08
|
| Rate for Payer: Blue Shield of California EPN |
$7.06
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Central Health Plan Commercial |
$11.54
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$10.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.27
|
| Rate for Payer: Dignity Health Media |
$12.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$12.27
|
| Rate for Payer: Global Benefits Group Commercial |
$8.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.99
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: Multiplan Commercial |
$10.82
|
| Rate for Payer: Networks By Design Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$12.27
|
| Rate for Payer: Riverside University Health System MISP |
$5.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.22
|
| Rate for Payer: United Healthcare All Other HMO |
$7.22
|
| Rate for Payer: United Healthcare HMO Rider |
$7.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.27
|
| Rate for Payer: Vantage Medical Group Senior |
$12.27
|
|
|
HC DRSNG PACKING STRIPS 1" PLAIN
|
Facility
|
IP
|
$14.43
|
|
| Hospital Charge Code |
901600272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Central Health Plan Commercial |
$11.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$12.27
|
| Rate for Payer: Global Benefits Group Commercial |
$8.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: Multiplan Commercial |
$10.82
|
| Rate for Payer: Networks By Design Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$12.27
|
|
|
HC DRSNG PACKING STRIPS 2"
|
Facility
|
IP
|
$57.15
|
|
| Hospital Charge Code |
901600278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$51.44 |
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Central Health Plan Commercial |
$45.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.86
|
| Rate for Payer: Galaxy Health WC |
$48.58
|
| Rate for Payer: Global Benefits Group Commercial |
$34.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.43
|
| Rate for Payer: Multiplan Commercial |
$42.86
|
| Rate for Payer: Networks By Design Commercial |
$37.15
|
| Rate for Payer: Prime Health Services Commercial |
$48.58
|
|
